CAROL M. RIVERA
Sullivan,Ohio
Summary
Dynamic professional with strong problem-solving abilities, a commitment to continuous learning, and excellent communication skills. Dedicated to contributing to team success and achieving positive results through collaboration and innovation. Eager to tackle new challenges and drive organizational objectives forward with enthusiasm. Adept at adapting to evolving environments and leveraging skills to deliver impactful solutions.
Overview
39
39
years of professional experience
Work History
Shop Owner
Self Employed
06.2014 - Current
- Manages a small handmade order business
- Makes and sells blankets, clothing, baby items and shopping bags
- Conducted regular market research to stay current on industry trends and align product offerings with consumer preferences.
- Addressed customer complaints effectively, resolving issues quickly to maintain overall satisfaction levels among clientele.
- Boosted customer satisfaction by providing exceptional service and addressing any concerns promptly.
- Expanded customer reach through active engagement on social media platforms, promoting the shop''s unique offerings while building an online community of brand advocates.
- Managed day-to-day business operations.
Medicare Billing Specialist
Orlando Regional Medical Center
02.2005 - 06.2014
- Reviewed claims to convert from Medicare to the secondary insurance or self-pay, corrected incorrect contractual adjustments,
- Billed Medicare corrected bills in the E-Premis billing software
- Developed customized reports for management review, providing insight into trends affecting the organization''s financial performance.
- Audited patient accounts to identify discrepancies in billed services, correcting errors to ensure proper reimbursement.
- Managed a high volume of Medicare claims, ensuring timely submission and payment for medical services rendered.
- Assisted in maintaining HIPAA compliance, safeguarding patient information during the billing process.
- Participated in networking events within the healthcare industry to stay informed about changes affecting the field of medical billing.
- Maintained up-to-date knowledge of changing Medicare regulations and guidelines, ensuring accurate and compliant billing practices.
- Resolved complex billing issues by conducting thorough research and collaborating with relevant parties.
- Reduced claim denials by meticulously reviewing and correcting billing data prior to submission.
- Advised senior management on recommended improvements to the overall Medicare billing process, increasing efficiency and reducing potential for errors.
- Streamlined Medicare billing process by implementing an efficient electronic system, reducing errors and increasing accuracy.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
Billing Specialist
EMH Medical Center
02.1987 - 03.2004
- Company Overview: (now UH Elyria Medical Center)
- Corrected claims in the E-Premis billing software to send to all insurances,
- Researched and resolved billing discrepancies to enable accurate billing.
- Assisted colleagues in resolving complex billing issues, promoting teamwork and knowledge sharing within the department.
- Worked with multiple departments to check proper billing information.
- Identified, researched, and resolved billing variances to maintain system accuracy and currency.
- Contributed to improved financial reporting by reconciling discrepancies between invoiced amounts and actual payments received.
- Ensured compliance with industry regulations by staying up-to-date on changes in billing rules and guidelines.
- Proactively addressed potential billing discrepancies by conducting pre-billing audits.
- Identified opportunities for process improvement, leading to more streamlined billing operation.
- Contributed to positive work environment by offering support and guidance to junior billing staff.
- Assisted in transition to electronic billing, reducing paper waste and improving operational efficiency.
- Reduced billing errors, leading to decrease in customer complaints, by conducting regular audits of billing data.
- Maintained up-to-date knowledge of billing regulations and compliance requirements, ensuring adherence to legal standards.
- Facilitated staff training on new billing software, enhancing team productivity and billing accuracy.
Education
Associate degree - Business Management/Accounting, minor in Micro-processing
Lorain Business College (now Ohio Business College)
Lorain, OHGraduated with general degree -
Elyria High School
Elyria, OHSkills
- MS WORD
- MS EXCEL
- MS Power Point
- E-PREMIS billing software
- Knowledge CPT coding, ICD-9 and ICD-10 coding
Timeline
Shop Owner
Self Employed
06.2014 - Current
Medicare Billing Specialist
Orlando Regional Medical Center
02.2005 - 06.2014
Billing Specialist
EMH Medical Center
02.1987 - 03.2004
Associate degree - Business Management/Accounting, minor in Micro-processing
Lorain Business College (now Ohio Business College)
Graduated with general degree -
Elyria High School
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